What is a Liver Abscess?
Liver abscess is the medical condition where there is an accumulation of pus within the liver, resulting from an infection. It is also medically termed as hepatic abscess and it is the rare medical condition but it is widely found in people in many developing countries. It is important to know the causes, and symptoms of liver abscess in addition to the diagnosis and treatment options to manage the condition without any complications.
Liver abscess is mainly caused by a specific bacteria and amebic parasites. However, there are other fungi, protozoa and parasitic worms that may cause this medical condition in humans. The liver abscess may either occur as single or solitary abscess or multiple lesions that may vary in size and shapes. The size may range from a few millimeters to larger abscesses of several centimeters. This medical term liver abscess is also used to refer a biliary abscess which are basically multiple. It is a type of intra-abdominal abscess and can be related with other abscess in the abdominal region.
Causes of Liver Abscess
The causes of liver abscess are many, based on which the liver abscesses can be categorized into different types.
- Pyogenic Abscess – It is the type of hepatic abscess that is caused due to bacteria of either one or more species.
- Amebic Abscess – The single-celled parasite called ameba causes this type of liver abscess
- Fungal Abscess – It is caused due to fungi, especially yeast like Candida species
- Parasites Abscess – It is the rare type of liver abscess that are associated with helminths.
Among all these types of liver abscesses, the most commonly found is the pyogenic liver abscess and the main organisms causing it include:
Initially, conditions like appendicitis and abdominal infections were the primary causes of liver abscess in people. Fortunately, after the advent of advanced treatment procedures and management such incidences have been reduced. But some of the ascending infections related with bile duct infection is still the common cause of liver abscess in elderly people.
There are various routes through which bacteria can reach the liver and cause liver abscess. The routes mainly include
- Portal vein or artery, blood stream
- Ascending infection up to bile duct
- Direct infiltration from neighboring organs or site
- Penetrating injury across the abdominal walls.
Bacteria that reach the liver through artery or portal veins and biliary tract basically cause liver abscess that are small and in multiple numbers. Solitary liver abscess is caused because of penetrating injuries and direct infiltration. After the bacteria reach liver tissues the body starts isolating the microorganisms by keeping it off and promoting immune activity within the localized infection area. This results in accumulation of pus in liver which contain immune cells, cellular debris, bacteria, blood and tissue fluid and this is referred as abscess.
Risk Factors of Liver Abscess
- Age older than 70-75 years
- Residing or traveling to places where such infection is widespread
- Medicines like chemotherapy or steroids are a risk factor for liver abscess
- Medical conditions like diabetes, cancer, weak immune system
- Alcohol consumption is also a risk factor of liver abscess
- Malnutrition or poor nutrition.
Symptoms of Liver Abscess
The symptoms of liver abscess in people usually include:
People with liver abscess may experience symptoms of pain in right upper quadrant of abdomen which may extend to the left side and may accompany pain on your right shoulder. Other associated symptoms of liver abscess are:
- Chills, fever and malaise
- Feeling of nausea
- Anorexia or loss of appetite can also be a symptom of liver abscess
- Tenderness in liver region with enlargement of liver
- Jaundice in some rare cases
- Hiccups or cough due to irritation of diaphragm
- Joint pain
- Excessive sweating
- Dark urine
- Pleuritis or Chest pain
- Unexplained weight loss
- Clay-colored stool.
Some patients may have liver abscess without abdominal pain. In some rare cases, the sub-diaphragmatic liver abscess may also spread to thoracic cavity that causes lung abscess or empyema or pus around lungs. In such cases, cough or other complaints of the chest are mostly present.
Proper clinical examination and investigation is essential for appropriate diagnosis of liver abscess, so that proper treatment can be initiated at the earliest.
Diagnosis of Liver Abscess
Diagnosis of liver abscess is mainly based on the medical history or symptoms of liver abscess and present clinical presentation. The doctor will check the history of intra-abdominal infections and signs indicating so. Most of the patients usually suffer from liver abscess without abdominal pain and hence they may only report a fever of unknown origin. In such cases the diagnosis could be overlooked on previous clinical assessment.
For diagnosis of liver abscess the doctor may ask the patients to undergo a blood test through which the doctor will determine the bacteria or germs causing the infection. The laboratory studies usually include Complete Blood Count, LFT or Liver Functioning Test, Cultures of abscess fluid and Blood Culture. A CT scan or ultrasound of the abdomen may also be required to confirm the diagnosis.
Treatment for Liver Abscess
Medications are prescribed and if required, surgical drainage is advised for the treatment of liver abscess in people. The treatment of liver abscess offered is based on the type of liver abscess present. Patients with amebic liver abscess are usually treated with drugs which are prescribed to kill the ameba in the intestines and to prevent the recurrence of the condition.
Surgical procedures are also used as the treatment of liver abscess where the pus or abscess is drained out surgically using a needle or small tube which is penetrated through the abdomen. The surgical treatment for liver abscess is medically termed as percutaneous drainage or aspiration or laparoscopy
The medicines for liver abscess are prescribed as a part of the treatment that treats the infection caused by parasite, fungus and bacteria. Surgical treatment for liver abscess is only recommended when the size of the abscess is too big or if the patient has multiple numbers of abscesses. Surgery is also prescribed in the case where the abscess bursts. However, with timely diagnosis, appropriate treatment of liver abscess can be initiated with good results in most cases.